Study offers new hope to city’s heroin addicts
Fewer criminal acts reported after users given injectable painkiller
Offering a legal painkiller to heroin addicts can help them stop using street drugs and reduce the crime that goes with them, a Vancouverbased study released Wednesday concludes.
The finding, published by the Journal of the American Medical Association in JAMA Psychiatry, could open the way to prescribing hydromorphone to people who have been unable to quit street drugs using methadone or suboxone, the only two opiate substitutes approved in Canada.
Addictions researcher Eugenia Oviedo-Joekes headed SALOME — the study to assess longer-term opioid medication effectiveness — at Providence Health Care’s Crosstown Clinic in the heart of the Downtown Eastside on Hastings Street. It compared hydromorphone, an opioid pain medication sold under the brand name Dilaudid, with injections of the active ingredient in heroin called diacetylmorphine.
While methadone taken daily in liquid form is effective for most people who want to quit street opioids, it doesn’t work for at least 10 per cent of the chronically addicted, she says.
Max Bell is one of those users who spoke at a news conference Wednesday at St. Paul’s Hospital. He started down the road to opiate abuse after surviving a deadly car accident. Years of injecting heroin permanently changed his body chemistry, he says, so that nothing else could stop his daily cravings until he entered the study.
“It’s a physical illness. Your body starts to hurt. You become sick to your stomach. Your joints all hurt. Almost nothing will stop you from getting (heroin). Your body is screaming for it,” Bell says.
“What the program does for me is introduce a small amount of opiate into my system that holds me for several hours or longer so that my body’s not going through withdrawal. Then I’m able to get on with my daily things like work or going to appointments.
“So I’m not getting stoned — my body is just getting the chemicals it needs so that I can continue to go throughout the day and continue to function …
“I didn’t think I’d ever hit 50,” he adds about the landmark date he celebrated Tuesday. “It’s completely changed my life.”
SALOME recruited 202 heroin users between 2011 and 2015 who had a documented drug addiction for at least five years. Participants were randomly divided into two groups and regularly given syringes filled with either pharmaceutically prepared hydromorphone or medical heroin up to three times a day. Neither the patient nor the health-care worker handing out the syringes knew which drug they contained.
Study participants had a mean age of 44, had done drugs almost daily and reported committing criminal acts on 14 days in the month leading up to the study. After six months in the program, criminal days fell to three or four days a month in both test groups.
Urine tests revealed about 20 per cent of participants continued to use street heroin during the study.
SALOME is a followup to work by Oviedo-Joekes and fellow researchers called the NAOMI proj- ect. That 2005-08 study concluded prescribed heroin helped people who hadn’t benefited from methadone treatment to stop using street drugs and commit fewer crimes.
Requests to keep administering medical heroin to participants led to legal conflicts with the former Conservative government in Ottawa. Although it is still outlawed in Canada, the Crosstown Clinic gained an exemption through the courts to treat 110 patients daily with prescription heroin.
Because of the difficulty in obtaining medical heroin — it requires special permits from Health Canada that must be frequently renewed — researchers turned their attention to hydromorphone.
Twenty-five patients are currently taking hydromorphone daily by injection at the Crosstown Clinic.
“We’re trying with these treatments to advocate for a different way to see our patients,” OviedoJoekes says. “This is a treatment for people who have lost it all. I’m pretty sure no one wants to be there, so nobody fakes it.”
Crosstown’s physician Dr. Scott MacDonald says previous research shows providing heroin as a medication costs society less than drug addiction. A single drugaddicted person costs taxpayers at least $45,000 a year in petty crime, policing, courts, jail time and health care, he says. Administering either medical heroin or hydromorphone in Crosstown’s supervised clinic costs about $27,000 a patient each year, mostly in staff wages.
“The advantage of substitution treatment is that they don’t have to engage in whatever behaviours they were engaged in previously to get their fix, whether it was organized crime, dealing, sex trade work,” MacDonald says.
The $7.4-million SALOME study was funded by the Canadian Institutes of Health Research, the Inner-Change Foundation and St. Paul’s Foundation.
This is a treatment for people who have lost it all. I’m pretty sure no one wants to be there, so nobody fakes it.
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